Prognostic utility of serum 25-hydroxyvitamin D in patients with stroke: a meta-analysis
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REVIEW
Prognostic utility of serum 25‑hydroxyvitamin D in patients with stroke: a meta‑analysis Hongyu Liu1 · Jiaoqi Wang1 · Zhongxin Xu1 Received: 28 August 2019 / Revised: 18 October 2019 / Accepted: 19 October 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019
Abstract Background Conflicting findings have been reported on the prognostic significance of serum 25-hydroxyvitamin D level in patients with stroke. The objective of this meta-analysis was to evaluate the prognostic utility of serum 25-hydroxyvitamin D in stroke patients. Methods PubMed and Embase databases were systematically searched for potentially eligible studies until October 16, 2019. Observational studies investigating the association between serum 25-hydroxyvitamin D level and prognosis of patients with stroke were eligible. Multivariable adjusted risk ratios (RR) with 95% confidence intervals (CI) of poor functional outcome, all-cause mortality, and recurrence of stroke were pooled with the lowest versus the highest category of 25-hydroxyvitamin D level. Results Eleven articles (ten studies) involving 6845 stroke patients satisfied our predefined inclusion criteria. Lower serum 25-hydroxyvitamin D level was associated with an increased risk of poor functional outcome (RR 1.86; 95% CI 1.16–2.98), all-cause mortality (RR 3.56; 95% CI 1.54–8.25), and recurrence of stroke (RR 5.49; 95% CI 2.69–11.23). Sensitivity analysis further confirmed the above findings. Conclusions Lower serum 25-hydroxyvitamin D level is significantly associated with poorer prognosis in stroke patients. Future prospective studies are warranted to verify the prognostic role and to examine the association in different subtypes of stroke. Keywords 25-hydroxyvitamin D · Stroke · Functional outcome · All-cause mortality · Meta-analysis
Introduction Stroke is the second leading cause of death and long-term disability worldwide [16]. Survivors of stroke usually face high risk of recurrence. The prognosis of stroke can be grouped by survival, neurological and functional outcomes. Accurate prediction of outcomes is clinically important for the stroke patients. Blood biomarkers can provide important information for predicting stroke outcomes [17].Vitamin D plays a vital role in cardiovascular pathophysiology [1]. Deficiency of Vitamin D is a growing public health concern, particularly for the elderly population [6, 19].
* Zhongxin Xu [email protected] 1
Circulating 25-hydroxyvitamin D is recognized as the best indicator of vitamin D status [7]. Acute stroke patients usually exhibit the high prevalence of low 25-hydroxyvitamin D level [22, 25]. Previous meta-analyses have confirmed that low 25-hydroxyvitamin D level was associated with an increased risk of stroke [24, 33]. Recent studies [4, 5, 8, 18, 20, 26] have linked the 25-hydroxyvitamin D deficiency and functional or survival outcomes. However, studies regarding the prognostic significance of vitamin D in stroke patients have produced controversial results [3, 31, 33]. No previous meta-analysis h
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